Building Healthier Communities Together

Purpose

VITAHLS was founded in 2011 to promote healthy lifestyles (focusing on nutrition and physical activity) to PreK-12 students, students’ families, and school staff in the Lower Naugatuck Valley. VITAHLS has been a combined effort of the Yale-Griffin PRC, Griffin Hospital, school districts (Ansonia, Derby, Naugatuck, Seymour, and Shelton), a partner from the CT State Department of Education, and community partners (the Naugatuck Valley Health District, Ansonia Chargers Club, Massaro Community Farm, ShopRite Supermarket, Boys & Girls Club, Valley Early Child Regional Council, and Valley YMCA). The PRC played an active leadership role in VITAHLS during its first 8 years. After 2019, leadership will be transitioned to school district representatives.

Goals

• Reduce the prevalence of obesity among students enrolled in the Lower Naugatuck Valley school districts
• Promote the health, wellbeing, and academic readiness of these students
• Develop a comprehensive and sustainable obesity prevention initiative focusing on nutrition and physical activity for grades Pre-K through 12
• Extend the health promotion efforts to include parents/families and school staff

Overview

The PRC employed a VITAHLS coordinator from 2013-2019 to develop health promotion materials, plan meetings and events, oversee data collection, and serve as a resource for schools. Representatives of the PRC, school districts, and community partners attended monthly working group meetings. Health promotion efforts evolved and expanded over time and included: nutrition and classroom-based physical activity programs for elementary school students; a middle school nutrition program; an annual healthy cooking competition; a cookbook; school gardens; farm field trips; a nutritional scoring system in school cafeterias; a “Smarter Lunchroom” design in one cafeteria; physical activity videos featuring local high school students; and weekly “Valley Health Challenge” messages tailored to students. The PRC provided mini-grant funding to support staff-driven health promotion projects.

Evaluation

During the 2014-2019 funding period, VITAHLS served as the school-based “epicenter” of our Community Health Opportunities Organized with Schools at the Epicenter (CHOOSE) core research project. We evaluated the impact of the initiative on outcome measures in students, including changes in students’ body mass index (BMI), fitness levels, and academic performance in repeated cross sections of students over time. We also assessed: awareness of VITAHLS among school staff; uptake of VITAHLS-related programs in schools; and the perceived impact of VITAHLS among school partners.

Findings

Student BMI: BMI z-scores generally did not change from the 2011-2012 to 2017-2018 school years, except in one district that had declines in both measures. The number of students, grade levels assessed, and timing of assessments varied from year to year and among districts, making comparisons between districts or over time somewhat challenging.

Student fitness: Fitness test scores, reported by districts to the state of CT, improved in VITAHLS districts from 2011-2012 to 2017-2018, whereas scores for the state overall remained flat. Because these were aggregate data reported by grade, it was not possible to determine whether these differences were statistically significant.

Student academic performance: There were no notable changes in performance measures in any of the districts.

Program inventory survey: More than 50 nutrition and physical activity programs / activities / policies were implemented during this project period.

Partnership/staff survey: 125 staff from across the school districts responded to a post-program survey. Among the respondents, 25% were “very familiar” with the VITAHLS initiative, 57% has some awareness of it, and 18% had never heard of it.

Perceived impact of VITAHLS among school partners: Benefits included: access to information; professional development opportunities; networking; inter-district collaborations; links to community organizations; student wellness emphasis; ideas for staff wellness; mini-grant funding; other grant opportunities; leveraging the partnership to obtain funding from other sources; support in setting up school gardens; and an enhanced ability to address issues through shared efforts. Challenges included: inability of some staff to attend working group meetings without substitute coverage; lack of authority among some staff to make decisions on behalf of their respective schools or districts; and a lack of awareness of the VITAHLS initiative among students’ families or other school staff.

Funding

Funding was provided for VITAHLS from 2011 through 2019. The primary funding source was the Centers for Disease Control and Prevention (CDC), with supplemental funding from Griffin Hospital and the Jones Family Farm. In addition, supplemental grant funding was provided directly to the school districts from the CT Department of Education, the Katherine Matthies Foundation, and other sources.

Collaborations between schools and universities and/or health organizations can enhance schools’ capacity to attend to student health and wellness and increase the impact that researchers and population health professionals can have on their communities. Here are some lessons learned about the best approaches to these collaborations.

• Groups wishing to work with schools must understand the many obligations that school staff are required to meet and the competing priorities they must balance. The most effective approach seems to be the integration of health promotion education, programming, activities within the school day/infrastructure, via policy, environment and environmental changes.
• The perceived value of the partnership must outweigh the perceived cost involved.
• Efforts should be made to engage administrators as much as possible. They have the authority to make decisions on behalf of entire districts or school buildings, can attend meetings more easily because they often do not need substitute coverage, and can have a great deal of influence on other staff.
• The frequency and duration of meetings should be minimized, as teachers and school nurses require substitute coverage to attend meetings during the school day.
• The opportunity to network and share ideas with peers at meetings is something that school staff may find especially valuable. A successful collaboration should include some opportunities for individuals from different schools and/or districts to come together in person to share information and learn from each other.
• Access to resources and programs may also provide a sense of value to school partners, but these should be easy to use, ideally free, and explicitly supported by district leadership.

• At a minimum, any programs offered to schools should be free or very low cost and require little training to implement. School districts are stretched financially and teachers and staff are overwhelmed with demands on their time. They will be more interested in programs that are easy to implement and do not require funding.
• Providing funding to schools, even small amounts, empowers school staff to conduct their own wellness activities with good follow-through.
• In evaluating school-based interventions, researchers should select outcome measures that are valid indicators of change in the targeted outcomes and also place minimal burden on schools.
• When possible, researchers should conduct the data collection themselves to ensure that methods are standardized. When school staff must be involved in data collection, it may be best to use data that schools are already collecting, but to try to obtain de-identified individual-level data to allow for statistical analysis. In districts with high turnover rates, it would be preferable to follow individual students over time.